Medical Claims Negotiator

Are you a highly motivated individual with a passion for helping others? Do you have experience in the healthcare industry and a knack for negotiating? If so, we have an exciting opportunity for you to join our team as a Medical Claims Negotiator at Aetna. As a leading healthcare company, we are dedicated to providing quality care and affordable solutions for our customers. In this role, you will play a vital role in ensuring accurate and fair settlements for medical claims. We are seeking individuals who possess strong communication skills, attention to detail, and a commitment to delivering exceptional customer service. If you are ready to make a positive impact in the healthcare industry, we encourage you to apply for this position.

1. Negotiate medical claims: The primary responsibility of the Medical Claims Negotiator will be to negotiate and settle medical claims on behalf of Aetna and its customers. This will involve reviewing claims, gathering necessary information, and using negotiation techniques to reach a fair settlement.
2. Review and analyze claims: The Medical Claims Negotiator will be responsible for reviewing and analyzing medical claims to ensure accuracy and compliance with company policies and procedures. This will require attention to detail and the ability to identify potential issues or discrepancies.
3. Provide exceptional customer service: The successful candidate will be expected to provide exceptional customer service to both internal and external stakeholders. This may involve communicating with healthcare providers, customers, and other team members to resolve issues and answer inquiries related to medical claims.
4. Utilize healthcare industry knowledge: The Medical Claims Negotiator will be expected to have a strong understanding of the healthcare industry, including medical terminology, procedures, and regulations. This knowledge will be essential in accurately assessing claims and negotiating settlements.
5. Maintain accurate records: It will be the responsibility of the Medical Claims Negotiator to maintain accurate and detailed records of all claims and negotiations. This will ensure transparency and accountability in the claims settlement process.
6. Collaborate with team members: The Medical Claims Negotiator will work closely with other team members, including claims adjusters and customer service representatives, to resolve complex claims and provide support as needed.
7. Continuously improve processes: Aetna is committed to providing quality care and affordable solutions for its customers. As a Medical Claims Negotiator, you will be expected to contribute to this mission by identifying opportunities for process improvement and implementing solutions to enhance efficiency and accuracy in the claims settlement process.
8. Adhere to company policies and procedures: The successful candidate will be expected to adhere to all company policies and procedures, as well as applicable laws and regulations, in the performance of their duties. This will ensure compliance and mitigate risk for the company.
9. Uphold confidentiality: The Medical

According to JobzMall, the average salary range for a Medical Claims Negotiator in Plymouth, MN, USA is $45,000 to $55,000 per year. However, this can vary depending on factors such as experience, education, and the specific company or organization the individual is working for. It is always best to research the specific job market and company for more accurate salary information.

Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare. Since November 28, 2018, the company has been a subsidiary of CVS Health.